Page 106 - Medicare Benefit Policy Manual

symptoms, or treatment (such as medication or surgery) may have changed the
patient’s audiological condition with or without awareness by the patient.

Examples of appropriate reasons for ordering audiological diagnostic tests that could be
covered include, but are not limited to:

• Evaluation of suspected change in hearing, tinnitus, or balance;

• Evaluation of the cause of disorders of hearing, tinnitus, or balance;

• Determination of the effect of medication, surgery, or other treatment;

• Reevaluation to follow-up changes in hearing, tinnitus, or balance that may be
caused by established diagnoses that place the patient at probable risk for a
change in status including, but not limited to: otosclerosis, atelectatic tympanic
membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection,
Meniére’s disease, sudden idiopathic sensorineural hearing loss, autoimmune
inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity
secondary to medications, or genetic vascular and viral conditions;

• Failure of a screening test (although the screening test is not covered);

• Diagnostic analysis of cochlear or brainstem implant and programming; and

• Audiology diagnostic tests before and periodically after implantation of auditory
prosthetic devices.

If a physician refers a beneficiary to an audiologist for testing related to signs or
symptoms associated with hearing loss, balance disorder, tinnitus, ear disease, or ear
injury, the audiologist’s diagnostic testing services should be covered even if the only
outcome is the prescription of a hearing aid.

D. Individuals Who Furnish Audiology Tests.

1. Qualified Professionals. See section 80.3.1 of this chapter for the qualifications of
audiologists. See section 80.6 of this chapter for the qualifications of physicians and
NPPs who may furnish diagnostic tests.

2. Qualified Technicians or Other Qualified Staff. References to technicians in this
section include other qualified clinical staff. The qualifications for technicians vary
locally and may also depend on the type of test, the patient, and the level of participation
of the physician who is directly supervising the test. Therefore, an individual must meet
qualifications appropriate to the service furnished as determined by the MAC to whom
the claim is billed. If it is necessary to determine whether the individual who furnished
the labor for appropriate audiology services is qualified, MACs may request verification